history of tachycardia/help with holter monitor results

Can anyone help me interpret the results of a recent holter monitor test?  I am getting the runaround with my PCP and can't get in to see the cardiologist for 3 weeks, so I'm trying to do my research in the meantime.

I am a 35-year-old woman who was diagnosed with paroxysmal atrial tachycardia as a teenager.  At 25 I was treated for supraventricular tachycardia with radiofrequency ablation, but it was not completely successful.  My episodes of tachycardia decreased in frequency and seem easier to manage, but still occur on occasion.  Last month I went to see my PCP for dizziness.  I had made no correlation between the episodes of dizziness and the occurrence of tachycardia, but because of my history, she ordered a holter monitor test.  While waiting for the results, I also saw an ENT specialist who recommended nasal irrigation due to chronic congestion.  Since then I have had no episodes of dizziness, which suggests to me that it was sinus-related, not heart-related, but then I got the holter monitor results that seem to indicate I do have an arrythmia.

These are the results; can anyone help put them  in layman's terms???
Normal sinus rhythm with sinus arrythmia, sinus tachycardia (6%) and sinus bradycardia (1%).  Maximum R-R intervals 1.2 seconds.  Heart rate from 57 to 143 bpm.  Average heart rate 80 bpm.  Rare, isolated, mostly multifocal PVCs (4).  Rare, bigeminal, PAC cycles (18).  One PAC couplet.  Occasional isolated PACs (144).  Patient recorded "dizziness" (2) and "slight chest discomfort" (1).  One episode correlated with sinus tachycardia, 102 bpm, and no ectopic beats.  Two episodes correlated with NSR, 69-75 bpm, and no ectopic beats.  Patient stated that it was not distinct enough to pinpoint a moment in time to mark incidence of dizziness.

[Momto3]

I can tell you what some of the terminology means, but cannot interpret the test at all....

Sinus arrhythmia is "the normal increase in heart rate that occurs during inspiration (when you breathe in). This is a natural response and is more accentuated in children than adults.  The 'sinus' refers to the natural pacemaker of the heart which is called the sinoatrial (or sinus) node." http://www.medterms.com/script/main/art.asp?articlekey=9745

Sinus tachycardia is "a rhythm with elevated rate of impulses originating from the sinoatrial node, defined as a rate greater than 100 beats/min in an average adult."

During the monitoring, your heart rate was anywhere between 57 to 143.  It is normal for your heart rate to fluctuate depending on what you are doing.  Only your doctor would know if these numbers were of any other significance.  During the test, your average heart rate was 80 beats per minute.

You had "rare" instances of multifocal (originating from more than one foci, place) pvcs (premature ventricular contractions.  PVC's are extra beats that start in the ventricles (lower chambers of the heart).  MANY people have pvcs.

Bigeminal (every other beat) PAC, or premature atrial contractions (originating in the upper chambers of the heart).  A PAC couplet is two PAC's in a row.  Based on the information above, I'd say that the number in parenthesis is the number of each of these ecoptic occurrences.  For example, you likely had 4 pvcs, 18 pac bigeminal cycles....

during the test, you wrote down what you were feeling at different times.  You recorded 2 episodes of dizziness and 1 occurrence of slight chest discomfort.  One of the episodes occurred at the same time (correlated) as the sinus tachycardia (when your heart was beating at 102 bpm).  During that "episode" you were not having any ectopic (pvcs, pacs) beats.

Two of the recorded events correlated to normal sinus rhythm (normal rhythm), and there were no ectopic beats.  

Hope that helps.  It is not meant as any type of diagnosis, just some information about the terminology.  Please keep the appointment with your doctor so you will have the best understanding of the entire test and its results.  Have a great day!

[Artaud]

Hi,

For your results, Bradycardia refers to any heart rate below 60 Beats per minute (BPM). Your heart rate dropped to 57 BPM, likely when sleeping. This is normal. I take Beta Blockers and my resting heart rate has dropped as low as 56 BPM, being slower still at night. Bradycardia is usually a concern when the heart rate drops significantly below 60 BPM (yours did not). If you slept for a few hours, I can see how the Bradycardia (slower then 60 BPM) accounted for 1% of the total beats.

Sinus Tachycardia, according to Wikipedia, is any heart rate greater then 100 PBM. Sinus, as described in the previous post, refers to signals coming from the heart's natural pacemaker, and the Sinus Tachycardia recorded may have been from exertion (such as walking up steps) and is not necessarily an abnormal occurrence of rhythm. I believe that your rate is described as being above Tachycardic (above 100 BPM) for 6% of the overall beats. Again, depending on your activities while wearing the Holter, this may not be of significance. Playing with the numbers, in an imprecise way, I would guess that since your Average Heart Rate was 80 BPM, and you wore the Holter for 24 Hours (give or take), that 80 BPM X 60 Minutes (per hour rate) X 24 Hours (per day rate) would be your overall number of Heart Beats during the test, or 115200 Beats. If 6% of them were Tachycardic, 115200 X .06 = 6912 Beats. Remember that any activity sufficient to raise your heart rate above 100 is considered Tachycardia, so if you were active, that may account for the 6%.

I believe that the NSR refers to Normal Sinus Rhythm. If so, nothing needs to be said about it other than it was normal.

For Contrast, from my 24 Hour Holter ending on 26 July 2007:

“Interpretation:
The underlying rhythm is normal sinus. The average rate is 59 bpm, minimum of 51 bpm, maximum of 91 bpm. 604 Single PVCs. 24 PACs. The Patient complained of a series of PVCs, frequent PVCs, missed beats, pain in the left chest, and a run of PVCs. Most of the complaint did not correlate with symptomatology. There were no additional ST Changes.

Conclusion:
The underlying rhythm is sinus with occasional PVCs, most of which were felt. No significant ST changes and no evidence for sustained ventricular ectopy.”

You can see that he avoided the Technical Use of the word Bradycardia to describe rhythms below 60 BPM. My rate never made it above 100, so the use of the word Tachycardia was never appropriate. I had 604 Single PVCs (Premature Ventricular Contractions) and 24 PACs (Premature Atrial Contractions). The oddest thing about wearing a Holter Monitor is it almost always represents days when I have less problems with my rhythm. I'm beginning to think that the lead placement may cancel out the bad rhythms ;-)

I trust that your PCP is aware of the results and sees no problems with them that require immediate attention? Keep in touch with your Doctor (PCP) if symptoms change.

Be healthy.

[maggiemag]

Sounds normal to me!  Relax and enjoy your life!

[tickertock]

arctictern, we call an arctictern a spratbird around where I live, travels over 11,000 miles, I enjoy watching them diving for fish around here on their long haul, your test from what I know, it is completely within the normal limits and no cause for alarm. be well and my advice is to try and forget you have an heart :-)

[arctictern]

Thanks to all of you for your help!